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Compassion Activist – Robin Youngson – retires from role

16 April 2019

Dr Robin Youngson, the cofounder of Hearts in Healthcare, is retiring from his fifteen-year role as an activist, speaker and leader.

I have decided to retire from active involvement in Hearts in Healthcare work. I will no longer be speaking, consulting or running workshops. My stepping down is an invitation to new leaders to take up the cause of compassionate healthcare. That task is now much less daunting than the circumstances I faced when I set out on this quest in 2004.

It’s hard to imagine how different the world was then. At that time, the word ‘compassion’ was almost completely absent from medical journals, from medical training, and from the discourse about medical professionalism. Even nursing, with long traditions in the compassionate care of the patient, seemed to have become an academic speciality. It was very hard to find the word compassion in nursing journals.

In those early years of campaigning, I did a Google search for ‘compassion+healthcare’ and found no relevant results at all, except for one mention of compassion in a speech by the UK Minister of Health. In country after country, I systematically examined the national health strategies and frameworks for healthcare quality; the concept of compassion was absent. When I searched the entire website of the Institute of Healthcare Improvement (IHI), the world’s most eminent health quality organisation, I found not a single instance of the word compassion.

Although compassion was an assumed value in healthcare it was neither taught nor advocated. Medical training was still focussed on objectivity and clinical detachment. Nobody was teaching students that the quality of relationship between health professional and patient had a significant impact on clinical outcomes. The neuroscience of compassion was in its infancy. Health systems had suffered a decade of corporate managers, who emphasised efficiency and productivity, not humane care of the vulnerable patient.

I stepped into this compassion void after witnessing the plight of my daughter Chloe, hospitalised for three months with a broken neck and spine. Her clinical care was excellent. The neglect of her emotional and human needs was shocking. At the time, I was a senior health leader but none of my power and influence helped my daughter get the care she needed. Out of deep frustration, I vowed to change the system. I created a website and began recruiting supporters. It seemed that others shared my concerns.

In New Zealand I launched a national campaign to change the national Code of Rights and to add a new right in patient care: the right to be treated with compassion. My proposal caused an uproar. The Code of Rights in NZ is set down in law and the Commissioner is required to consult the public each five years for possible amendments to the Code. In the light of my controversial proposal, all the professional bodies and stakeholders felt bound to make written submissions. About half the submissions were strongly in support of our proposal; half vehemently opposed it.

After debating the issue at a national workshop, the proposal was narrowly defeated. The Commissioner subsequently argued that you cannot regulate for compassion, in a scholarly article published in the Journal of Law and Medicine.

Looking back, I think he was probably right although I was disappointed at the time.

I began to get invitations to speak at conferences. Time after time, I stepped on the stage and spoke about the importance of compassionate care of the person, not just the clinical care of the patient. I spoke about the inhumanity of the health system and my own experience of being brutalised in medical training. I talked about the need to change the medical culture, and reminded people that doctors have feelings too. I was willing to be vulnerable on the stage and I sometimes shed tears. Audiences cried with me.

My earliest speaking invitations were from integrative medicine associations and the nursing professions. While I was internationally renowned as a speaker and leader, the mainstream medical professions ignored my work for a full decade.

When I first began this quest, I was also a national leader in healthcare quality and patient safety, advising the NZ government and the World Health Organisation. However, within those bureaucratic structures, I was completely unable to progress an agenda of humane and compassionate care. Eventually, I quit those roles and instead launched an international social movement supported with a new website and online networks.

What began as an emotional argument for compassionate care began to be supported by science. In 2012 I published my book, ‘TIME TO CARE’, which for the first time drew together a wide range of scientific research into the nature of human connection and the remarkable impact of compassionate caring on objectively measured clinical outcomes. I also shared ideas about positive psychology, self-care, and compassionate leadership so that health professionals might learn to be more resilient. I used the book to launch our international movement, Hearts in Healthcare, which I co-founded with my wife Meredith.

That work to rehumanise healthcare has taken us to fifteen countries. In every country and culture we found the exact same issues: objectified patients, industrialised systems of care, and burnout of health professionals. Over those years we did hundreds of workshops with health professionals and used appreciative inquiry to draw out moving stories of compassion and healing. These stories powerfully reminded participants of the hopes and ideals that brought them into the caring professions and gave them practical examples of compassionate caring.

After many years of struggle, I started to realise that my own attitudes were sabotaging the success of our work. I began my quest feeling angry and judgmental. I was angry with hospital managers who allowed patients to be treated inhumanely within their institutions. I was angry with clinicians who wounded patients with their cold detachment. I was angry with a system that continued to brutalise and dehumanise idealistic young nurses and doctors. I was righteous in my calls for a different kind of a system. These attitudes only created resistance to our message.

As I reflected on our struggles, I realised that there was a disconnect between the values we were trying to promote and how we did our work. Self-reflection reminded me that a critical component of compassion is non-judgment. I let go of my anger and began to have compassion for the managers and doctors I had previously judged – they too were suffering and deserved my compassion.

As I softened my stance, I no longer tried to persuade people to change. In our workshops, Meredith and I found ways to draw out the compassion and strengths of the participants, thus our students became our teachers. We also changed our business model and no longer charged a fee for speaking or consulting. People supported us with generous donations.

Through these years, the science changed too. My friend Jim Doty, a renowned Stanford neurosurgeon and philanthropist, founded CCARE, the Centre for Compassion and Altruism Research and Education. The advances in science now fill an entire Oxford Handbook of Compassion Science. Simultaneous research advanced the science of mind-body connection, the way that emotional wellbeing affects physical illness, and the underpinning science of neuroplasticity and epigenetics.

A new, peer-reviewed Journal of Compassionate Health Care was launched by BioMed in 2014. I was honoured to write the very first article, which appeared on Page 1 of Volume 1. (Sadly, BioMed decided to cease publishing this journal in 2018 but all the previous content is available). Other prestigious medical journals began to publish editorials and articles about the importance of compassion and caring.

The concern about burnout of health professionals became widespread. I had long argued that we could not expect our doctors and nurses to show compassionate care to patients if they were bullied and brutalised within their own professions. Pastoral care of the medical trainee is now seen as an important part of professional development

Through all this time, at Hearts in Healthcare we have freely shared our resources and encouraged others to launch compassion projects in their own workplaces. My book, ‘TIME TO CARE’ is translated into several languages and has sparked movements in different countries. I was honoured to give the closing plenary address at the IHI Middle East Quality Improvement Forum, to an audience of 5,000 delegates. Increasingly, the patient’s experience of care is seen as a vital dimension of healthcare quality.

Since 2012, Meredith and I have also worked with the international Charter for Compassion and we have seen the spread of compassionate cities. In the city of Louisville, Kentucky, which we visited many times, there is now a compassionate medical school and many other compassion initiatives within the healthcare system. City leaders gather each year at a prestigious luncheon to celebrate compassionate caregivers.

A landmark event for me was speaking a few weeks ago at the very first ‘Compassion in Health’ conference in New Zealand, at the Auckland Medical School. Happily, I did not organise this conference because other leaders are taking up the cause. It was gratifying to see leading members of the NZ medical establishment in the audience.

In recent years the medical professions have taken much more interest in our work. Several of the medical and surgical colleges have invited me to speak at their conferences and meetings, a great honour. My own College of Anaesthetists (ANZCA) has supported my work. At anaesthetic conferences, the importance of compassionate care is now a common topic.

While writing this article I was curious to repeat my Google search for ‘compassion+healthcare’ and was astonished to now find 45 million pages. The result back in 2006 was only 3,000 pages.

In summary, new leaders in compassionate healthcare can build on secure foundations. The science of compassion is well-established. Multiple studies of compassionate caring have demonstrated a very significant effect on clinical outcomes. We know that the capacity for compassionate care can be enhanced through training. The institutional barriers to compassion have been researched and identified. We also know that encouraging health professionals to adopt compassionate caring helps protects them from burnout. The care and support of medical trainees is a recognised issue. It’s now OK to be labeled a compassionate doctor; not so long ago that was not a term of praise.

However, much needs to change. The science of compassionate caring must be introduced into the curriculum of medical training. Our institutions need to emphasise and reward human connection and compassion as much as hurried care. We need to start treating patients as people, not collections of pathology. Doctors need to acknowledge their own humanity, their feelings and vulnerabilities – this requires a huge shift in medical culture.

However, my work is done. After fifteen years of campaigning, it’s time for me to step down and let new compassion leaders emerge. We have paved the way and now we want you to take up the reins.

Will you take up the challenge?

The Hearts in Healthcare website will remain as a repository of resources and inspiration. My book, ‘TIME TO CARE’ is a primer in every aspect of the science and practice of compassion caring of the patient, and also compassionate self-care. It will soon be published in an expanded and updated second edition.

In the companion article, we lay out the resources freely available to you: a massive collection of slides with speaker notes and scientific references; guides to running your own workshops; many articles to inspire and challenge your followers; and YouTube videos sharing ideas about the science and practice of compassionate caring.

It has been an extraordinary journey. I have been blessed to have my wife Meredith at my side, guiding coaching and encouraging me. We’ve had the privilege of meeting thousands of passionate health workers, in many countries, who inspired us with their dedication and compassion. New leaders in compassionate care will be assured of a devoted following.

Hi Robin, I would also like to acknowledge you and Meredith and the work you have being doing to bring compassionate care into the health sector. I have been spreading your hearts in healthcare message and contact details to hundreds of participants across five NZ DHBs and I will continue to do so. Even, if you are not at the helm now, your legacy will live on and will never be forgotten. You are an inspiration to me and when I come to retire from public speaking and facilitating the Self-care in Healthcare programme, I hope I am able to have the same satisfaction that this work has made a difference in so many lives. Best wishes for the future.

Thank you both for your years of dedicated care and compassion in healthcare.
I have had the privledge of meeting you and will never forget the atmosphere of the room.
You are certainly an inspiration to all that you have touched.
Best wishes for your future.
Catherine

Robin what wisdom, as usual, Meredith and yourself show in making this monumental decision. I know there are now so many more people prepared and willing to take up the cause of compassionate healthcare than when we met all those years ago in Sydney. At that time our common passion was like a news flash to many who heard your story.
Since that time you have achieved so much, sacrificed so much, given so much. Thank you.
I wish both you and Meredith the very best in the future.
Bernadette

Tena korua Robin and Meredith.
I well remember Janell & I enjoying a barbeque at your former holiday home at Matheson’s Bay and you talking with us about the work you were embarking on in the realm of care and compassion. I can’t specifically recall when that was but I am thinking around 13 years ago. It was not difficult to get swept up in your enthusiasm and compassion and as someone who has experiences of (mainly) mental health services, you struck a chord with me Robin. And Meredith, you were also there for me in difficult times and with a bucket full of compassion.
I was privileged to be at your Time to Care book launch and to be one of the first people to become a member of Hearts in Healthcare. I am astounded – but not surprised – by the response you have had along the journey from people who wanted to hear you speak about compassion in health care – and in 15 countries of the world. Conversely, it is sad that the medical and healthcare profession has been slow in their uptake of your philosophies and practice Robin. However, there have been many wins in that area and I believe the growth of believers among your peers will have grown exponentially.
Best wishes to you both for whatever you have chosen to do together in the future.
With gratitude and admiration.
Arohanui
Gary

Dear Robin ,
Thank you for who you are, your vision, energy, commitment, and kindhearted, inspirational work .
Congratulations on what you have started , achieved and will continue to affect – even tho’ you have made the big decision to step down from the front line .
As I write , I am sat by the hospital bed of our semi- comatose family member as I write this ( her 5th admission since February). The anxiety of leaving her unattended is huge – some staff fantastic, some perfunctory, and recognition of her basic needs limited , and affected by staff shortages .
Even after 10 admissions in same hospital with same complex issues … I feel like a guard on duty here, trying to make the connections between different specialities , reminding them of recent treatments / investigations, and making sure she has meds, IV , and nutrients .. and feeling frustrated . Reading your message has been a huge reminder of why I started nursing 55 years ago , and leaves me recognising the need to treat the staff with compassion and at the same time get the right results is important .
Thank you for being in our lives Robin , and much love to you and Meredith for your new adventures !

Enjoy a well deserved retirement Robin and Meredith. I have watched your work from the sidelines and admired both your determination to change things and the reason behind your drive. As one with family working in the profession, I can only hope that they feel as you do. I believe they do. I also hope that the era of non medical managers might fade away so that those with compassion will be the leaders of the future. Having said that, I was treated with compassion by most with whom I came in contact during my most recent hospital stay.
Arohanui.

Robin – I will always be in awe that a doctor can show such heart. Thanks for the healing words. Thanks for fighting the cause. Thanks for trying to combine the needs of ‘Them & Us’. You both deserve a fabulous retirement! I’m coming to the end of my activist years, but occasionally still achieve a little.

Tena koe Robin
Many Congratulations for the changes in thinking and changes in practise that you have stimulated through your work. Thank you for your support of our work on relationship centred practise. You can take great satisfaction and pride that your work has made such a difference to the lives of the people that we are privileged to serve.
I particularly remember a conversation we had when you influenced me to carry out intentional acts of kindness.
Every kind wish for your future
Andy

I’m currently in the middle of burnout. I started writing a journal article the other day (not yet completed or published) where I tried to put the bile and anger I have felt for 12 years as a junior doctor into writing. I really needed to try and process it.
I am so angry, but reading back through my words, and also, glancing at my historical fb statuses, I also feel sad and a little ashamed. I fear the anger has overtaken me, so I am no use to anyone. I’ve forgotten why I went into medicine in the first place. Why I wanted to care and look after people. The post read like an angry tirade.

Thank goodness for people like you who are trying to change the landscape. Because of you I feel much less alone and much less hopeless. I hope you don’t mind if I try and use some of your material to help others in my position.

Thank you so much for redeeming some semblance of belief in medicine and what it can, and should, be. Its such a hard, thankless road sometimes.

Robin your thoughts and website came into my vision at a time when I was screaming on my inside and trying to vocalise my concerns as well on who “Cares for the Carers”.
No one it seemed until you were brave enough to bring this vision to the fore.
I fell into a deep sad place as Registered Nurse of 43yrs with a sense of resignation after trying to change others in management in the hope of bringing about a sense they cared about their workers.
All I could do was turn to accept myself and my personal care of my patients and try to let go of the distress I felt.
Last year I was loaned Robins book and suddenly my vision cleared and I felt hopeful. I have been talking and sharing what I am reading to my colleagues and Manager and was gutted to miss the Conference recently in Auckland because I was new to facebook group.
My dream was to meet you Robin and that seemed within my grasp when I realised you actually lived in NZ😎
But now you are retiring and that is both awesome and sad.
Lets hope your inspiration can help motivate those of us crushed by the past decades of healthcare provision under a management style.
I too am finding healing and compassion for myself (after a long struggle for 22mths following an assault at work and the encompassing issues that arose) just hope can use that for a collective good in my last couple of years before retirement.
Wishing you and your Wife great peace in the coming years. Will be buying several copies of latest edition of Time to Care to distribute to colleagues and also covert one for myself.💗

Dear Robin and Meredith
I have watched , admired and learned greatly from your work, book and methods over the years – and it is extraordinary. Thank you for all the amazing work you have done and lives you have saved in both sides of the bedside. Take care in your future and enjoy your time moving forward.

Thank you -two very simple words with bucket loads of heartfelt meaning. You have made a huge difference in the world of healthcare and I am truly grateful to have met you and will carry on in my own small way to bring compassion into all my work. Please give Meredith a giant hug for her care and passion walking beside you all the way. Enjoy this next adventure 🌟

Robin I would like to add to the growing list of people honouring your work. I remember meeting you at the prompt of Dr Pitsilis and joining as a founding member of Compassion in Healthcare. I was so proud to be part of that and work with so many smart minds as it built and grew. I have danced in both health and business and continue to do so and am so heartened just recently to see Gary V has a Chief Heart Officer:). How amazing is that? She is there to build empathy. I did 4 national tours of Australia last year delivering a Mental Health in the workplace program to a corporation that employs 26,000 people mostly men. Among many other things they have a domestic violence program that just melts my heart. And they are up for having brave conversations….leading with heart …my blessings and love to you both ….you have been welcome balm for my soul. Pat

“When all members of an organization are motivated to understand and value the most favourable features of its culture, it can make rapid improvements.”